To modify the bladder neck dissection during radical prostatectomy, in
an effort to improve continence and diminish the incidence of anastom
otic stricture, without compromising the primary surgical objective of
complete cancer removal. Between December 1991 and August 1992, 50 pa
tients underwent radical retropubic prostatectomy with anatomic dissec
tion and preservation of the bladder neck and most proximal portion of
the prostatic urethra, thus creating a mucosal cuff for anastomosis t
o the urethral stump. There was tumor at the inked margin in 18 patien
ts (36%), however, in only 3 instances (6%) was there tumor at the bla
dder neck margin. In no instance was the bladder neck margin the only
positive margin. At a minimum follow-up of six months, all patients ar
e fully continent during routine activities, and in no patient has an
anastomotic stricture developed. Anatomic dissection and preservation
of the bladder neck and proximal urethra does not compromise surgical
margins. We believe this technique may play a role in preservation of
continence after radical prostatectomy and probably decreases the like
lihood of anastomotic stricture, by allowing for a circumferential muc
osa-to-mucosa anastomosis without the need for bladder neck reconstruc
tion.